Okay so the title of this post pains me. It’s so cringe, eye, roll and click-baity.
And it pains me that we have to be thinking about how to be more “efficient” and “productive” when the nature of the job needs so much rest, but here we are. It’s a sad reality in primary care / family medicine that there is just not enough time to do all of your job.
Most weeks I work over my contracted hours. It’s super difficult to see a patient, do all of the care coordination, and finish the note in the allotted time. I probably will never have it down, but I’ve gotten a bit faster over the years. (side note: the fact that I can say years now!!)
I’ve been working for almost 2 years now (July 20, 2022 will be my 2 years work-aversary), and in the beginning everything took sooooo long. This is mostly because we utilize so many resources in primary care. Between different teams in the office, referrals, and knowing what resources are available in the local community, it takes time to learn the system you work in. This definitely took me a year or more to feel like I sort of had an idea.
So the short answer: it just takes time. You learn to think faster once patterns become primed in your brain. The synapses have been formed and therefore those memories fire a bit faster when you start seeing similar cases/diagnoses/presentations. I’m now closing my notes a bit quicker and finishing ~an hour after my shift technically ends rather than two (LOL). I’m including a few more tips/tricks below.
- If you can sense there are multiple things a patient wants to address, sometimes I’ll start the appointment by saying “what’s the most important thing you want to discuss today.” Or “unfortunately we’re working within a system that limits our time together. What is most pressing. thing you’d like to talk about today and we’ll schedule close follow-up to discuss the remaining item(s).”
- Accepting that you can’t engage with everything. If you find yourself in one of those appointments where there are 20 things that need to be addressed and you’re already running over time, here are some things I will commonly say
- “It sounds like you’ve been dealing with all of these concerns for some time, and it’ll take us some to get through all of them. These first appointments can feel very unsatisfying, and I acknowledge that. So let’s do some blood work, put referrals in today, and schedule close follow-up so we can begin to tackle this list one at a time.”
- Writing notes during the appointment. I know it feels awful and like you’re taking away from the mindfulness in the appointment, but it’s the only way to get things done sort of on time.
- Utilizing smart phrases!!! If you use Epic, this is essential. All of my note templates are smart phrases so they’re easily customizable. I also use smart phrases for common diagnoses, treatments, and results so it’s pretty cut and paste.
- I stopped writing so much in my notes. I realized that people tune out / don’t read your note if it’s too long. So for the assessment and plan, I keep it as brief and succinct as possible.
- Ask your office what is available for team help. Sometimes nursing can help with result notes and messages that need to be triaged that come through your inbox. I am so grateful for our nurses!
- Utilize different resources! The ones I use the most are:
- ASCCP for paps
- MDcalc for algorithms
- USPSTF for preventive care
- ASCVD risk for 10-year risk of having cardiovascular problem
- US MEC/ US SPR for contraception
- UpToDate and Lexicomp for everything else
- Ask senior providers their tips! Every clinic operates differently so it’s best to get the inside scoop of what’s working for your seasoned providers.
- Prep work can sometimes can things go a bit quicker. I’ll get to work 15-20 min earlier so that I can do a bit of pre-charting / make a plan for the patients who seem really complex rather than having to do it on the fly. Anticipating that someone will need orthostatic vital signs, an A1c, UA, or EKG before the appointment ends up saving a lot of time!
- Learn to schedule your own patients. Having a few patients that you’re already familiar with / you already know the plan and follow-up makes things go so much quicker!
- Schedule lots of follow-ups. The only way I feel like I don’t lose my mind is scheduling frequent televisits. If a lab is abnormal or I suspect I’ll be on the phone with a patient for more than 10 minutes, I’ll make it a televisit. I like having the dedicated space for the patient so I feel like I can give them my undivided attention.